cardiothoracic and vascular anesthesia department of anesthesiology
DESCRIPTION
Impact of Autologous Platelet Rich Plasma Transfusion On Clinical Outcomes In Ascending Aortic Surgery With Deep Hypothermic Circulatory Arrest. SF. Zhou, MD, A. Estrera, MD, T. LI, MD, C. Ignacio, MD, S. Panthayi, MD, H. Safi, MD, A.Chuang, Ph.D. R. Sheinbaum, MD. - PowerPoint PPT PresentationTRANSCRIPT
Impact of Autologous Platelet Rich Plasma Transfusion On Clinical
Outcomes In Ascending Aortic Surgery With Deep Hypothermic Circulatory
Arrest
Cardiothoracic and Vascular AnesthesiaDepartment of Anesthesiology
The University of Texas Medical School at Houston
SF. Zhou, MD, A. Estrera, MD, T. LI, MD, C. Ignacio, MD, S. Panthayi, MD, H. Safi, MD,
A.Chuang, Ph.D.
R. Sheinbaum, MD
Autologous Platelet Rich Plasma
HarvestingHarvestingPlatelet Rich PlasmaPlatelet Rich Plasma
WB
aPRPRBC
Collected by harvesting 15-20 ml/kg whole blood prior to CPB Fractionating off the PRP component.
The goal was a yield of 10-15 ml/kg of aPRP.
aPRP was used to reestablish hemostasis and significantly reduce intra-operative transfusions
Investigate the effect of aPRP transfusion on the clinical outcome of patients undergoing aortic arch surgery with deep hypothermic circulatory arrest (DHCA)
Purpose
Retrospectively reviewed 454 cases of ascending aorta and arch repair with DHCA.
Ages 18-80,
From Feb. 2003 to Dec. 2008.
200 patients underwent aPRP harvest and 254 patients did not.
Materials and Methods
Patient Demographics
Intra-OP transfusion
Unit Non-aPRP
Group aPRP Group
Difference p-value
N=254 N=200
PRBC 5.28 2.47 2.81 <0.0001
FFP 6.32 2.2 4.11 <0.0001
Platelets 10.52 2.99 7.53 <0.0001
Cryoprecipitate 6.65 0.70 5.95 <0.0001
Cell Saver 4.74 3.35 1.31 <0.0001
Perioperative Blood Transfusion
Results In the PRP group
39/200 (19.5%) received no transfusions
129/200(64.5%) received no platelet transfusion
70/200(35%) required 4 or less units of transfusion
Post-Operative Complications
ComplicationNon-aPRP
Group
N=254(% )
aPRP Group
N=200(%)
Total
N=454p-Value
Tracheotomy 32 (12.6%) 8 (4%) 40 0.0013
Coagulopathy
Re-Open in 24h
41(16.14%)
17 (6.69%)
18 (9.0%)
6 (3.0%)
59
23
0.0247
0.0749
Dialysis
CNS CVA
TIA
Encephalopathy
CV MI
Arrhythmia(AF)
Cardiac arrest
33 (12.9%)
21(8.27%)
6(2.36%)32(12.6%)
5(1.97%)
92(36.22%)
15(5.91%)
12 (6%)
5(2.5%)
4(2%)
10(5%)
3(1.5%)
73(36.5%)
9(4.5%)
45
26
10
42
8
165
24
0.0133
0.0086
0.7941
0.0055
0.7064
0.9510
0.5064
Discharge Outcome
Discharge Non-aPRP
GroupN=254(% )
aPRP Group
N=200(%)
TotalN=454
p-Value
Home
Long Term Care
Death
143 (56.97%)
88 (35.6%)20 (7.97%)
151 (75.5%)40 (20%)9 (4.5%)
29412829
0.00020.00020.0002
Morbidity
ConclusionsUse of aPRP in ascending arch
repair with DHCA surgery resulted in reduced morbidity and mortality.
Prospective randomized controlled studies are required.